[PART VI. 
MISCELLANEOUS PROVISIONS]



 



[§431:10A-601]  Reciprocal beneficiary
family coverage defined; policyholder and employer responsibility for costs;
availability.  (a) Any other law to the contrary notwithstanding,
reciprocal beneficiary family coverage, as defined in subsection (b), shall be
made available to reciprocal beneficiaries, as defined in chapter 572C, but
only to the extent that family coverage, as defined in section 431:10A-103, is
currently available to individuals who are not reciprocal beneficiaries.



(b)  As used in this section, "reciprocal
beneficiary family coverage" means a policy that insures, originally or
upon subsequent amendment, a reciprocal beneficiary who shall be deemed the
policyholder, the other party to the policyholder's reciprocal beneficiary
relationship registered pursuant to chapter 572C, and dependent children or any
child of any other person dependent upon either reciprocal beneficiary.



(c)  If a reciprocal beneficiary policyholder
incurs additional costs or premiums, if any, by electing reciprocal beneficiary
family coverage under this section, the employer may pay additional costs or
premiums. [L 1997, c 383, §4; am L 2004, c 122, §37]



 



Attorney General Opinions



 



  Section applied only to insurers, and not mutual benefit
societies or health maintenance organizations.  Att. Gen. Op. 97-5.



  As provided by subsection (c), an employer does not violate
the reciprocal beneficiaries act [L 1997, c 383] if it chooses not to pay any
additional cost or premium incurred by the employee in electing reciprocal
beneficiary family coverage.  Att. Gen. Op. 97-10.



  Section applied to all parts of article 10A if the category
of policy under consideration included family coverage, as defined in
§431:10A-103.  Att. Gen. Op. 97-10.



  The division will be responsible for enforcement of health
insurance provisions of the reciprocal beneficiaries act [L 1997, c 383]; those
provisions can only be enforced against insurers, not employers.  Att. Gen. Op.
97-10.



  The employer is not required to pay the additional costs
incurred by an employee's election for reciprocal beneficiary coverage.  The
focus is on the insurance contract and the policyholder and recognizes that the
reciprocal beneficiary, as policyholder, is the one who incurs the cost.  Att.
Gen. Op. 97-10.



  The placement of this section in article 10A makes clear that
the legislative intent was to mandate benefits that must be made available by
insurers that write contracts of insurance providing family coverage; moreover,
the statute specifies that the coverage be made available to reciprocal
beneficiaries, not to employers.  Att. Gen. Op. 97-10.



  There is nothing in the reciprocal beneficiaries act [L 1997,
c 383] that would prevent an insurer from making reciprocal beneficiary family
coverage available in a policy separate from the policy it uses to make regular
family coverage available.  Att. Gen. Op. 97-10.



  To the extent that the reciprocal beneficiaries act [L 1997,
c 383] does impose obligations on insurers, it may provide a basis for affected
persons to seek relief by, for example, seeking declaratory relief under
chapter 632.  Att. Gen. Op. 97-10.